Form ID

Publication date

Location of premises

Certificate

Nibinamik Nursing Station

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Health Canada
Address of Owner
Summer Beaver ON
Name of Contractor
Lakehead Burner Service Ltd.
Address of Contractor
801 Gore Street, Thunder Bay, ON P7E 3S7
Name of Certifier
Lynx North Engineering Inc.
Address of Certifier
200 Johnson Ave., Thunder Bay, ON

Office to which claim for lien must be given to preserve lien

Lynx North Engineering Inc.